Necrotizing soft-tissue infections and primary sepsis caused by vibrio vulnificus and vibrio cholerae non-O1

Yao Hung Tsai, Tsung Jen Huang, Robert Wen Wei Hsu, Yi Jan Weng, Wei Hsiu Hsu, Kuo Chin Huang, Kuo Ti Peng

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42 Citations (Scopus)

Abstract

BACKGROUND: Vibrio species are a rare cause of necrotizing soft-tissue infections and primary septicemia, which are likely to occur in patients with hepatic disease, diabetes, adrenal insufficiency, and immunocompromised conditions. These organisms thrive in warm seawater and are often present in raw oysters, shellfish, and other seafood. This study examined fulminating clinical characteristics of Vibrio vulnificus and Vibrio cholerae non-O1 soft-tissue infections and identified outcome predictors. MATERIALS: Thirty patients with necrotizing fasciitis and sepsis caused by Vibrio species were retrospectively reviewed. Twenty-eight patients had a history of contact with seawater or raw seafood. Eight patients had hepatic disease such as hepatitis or liver cirrhosis, and seven patients had diabetes mellitus. Nine patients had hepatic dysfunction combined with diabetes mellitus. Microbiology laboratory culture studies confirmed V. vulnificus in 23 patients and V. cholerae non-O1 in seven patients. RESULTS: Surgical debridement or immediate limb amputation was initially performed in all patients with necrotizing soft-tissue infections. Eleven patients (37%) died within several days of admission and 19 survived. The mortality of V. cholerae non-O1 group (57%) is higher than that of the V. vulnificus group (30%). A significantly higher mortality rate was noted in patients with initial presentations of a systolic blood pressure of ≤90 mm Hg, leukopenia, decreased platelet counts, and a combination of hepatic dysfunction and diabetes mellitus. CONCLUSIONS: Vibrio necrotizing soft-tissue infections should be suspected in patients with appropriate clinical findings and history of contact with seawater or seafood. V. cholerae non-O1 may cause bacteremia more often than V. vulnificus in patients with liver cirrhosis. Early fasciotomy and culture-directed antimicrobial therapy are aggressively recommended in patients with hypotensive shock, leukopenia, high band forms of white blood cells, decreased platelet counts, severe hypoalbuminemia, and underlying chronic illness, such as hepatic dysfunction and diabetes mellitus.

Original languageEnglish
Pages (from-to)899-905
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume66
Issue number3
DOIs
Publication statusPublished - Mar 2009
Externally publishedYes

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Keywords

  • Fasciotomy
  • Necrotizing
  • Sepsis
  • Vibrio cholerae non-O1
  • Vibrio vulnificus

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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